• Michael Goldfarb, Melissa Bendayan, Lawrence G Rudski, Jean-Francois Morin, Yves Langlois, Felix Ma, Kevin Lachapelle, Renzo Cecere, Benoit DeVarennes, Christo I Tchervenkov, James M Brophy, and Jonathan Afilalo.
• Division of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Centre for Clinical Epidemiology, Lady Davis Institute, McGill University, Montreal, Quebec, Canada.
• Can J Cardiol. 2017 Aug 1; 33 (8): 1020-1026.

BackgroundFrailty is a risk factor for mortality, morbidity, and prolonged length of stay after cardiac surgery, all of which are major drivers of hospitalization costs. The incremental hospitalization costs incurred in frail patients have yet to be elucidated.MethodsPatients aged ≥ 60 years were evaluated for frailty before coronary artery bypass grafting or heart valve surgery at 2 academic centres between 2013 and 2015 as part of the McGill Frailty Registry. Total costs were summed from the date of the index surgery to the date of hospital discharge. Mutivariable linear regression was used to determine the association between preoperative frailty status and total costs after adjusting for conventional surgical risk factors.ResultsAmong 235 patients included in the analysis, the median age was 73.0 years (interquartile range [IQR], 70.0-78.0 years) and 68 (29%) were women. The median cost was $32,742 (IQR, $23,221-$49,627) in 91 frail patients compared with $23,370 (IQR, $19,977-$29,705) in 144 nonfrail patients. Seven extreme-cost cases > $100,000 were identified, and all of the patients in these cases exhibited baseline frailty. In the multivariable model, total costs were independently associated with frailty (adjusted additional cost, $21,245; 95% confidence interval [CI], $12,418-$30,073; P < 0.001) and valve surgery (adjusted additional cost, $20,600; 95% CI, $9,661-$31,539; P < 0.001).ConclusionsFrailty is associated with a marked increase in hospitalization costs after cardiac surgery, an effect that persists after adjusting for age, sex, surgery type, and surgical risk score. Further efforts are needed to optimize care and resource use in this vulnerable population.Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

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